Archdiocese Of Los Angeles Family And Medical Leave Forms Page 4

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2) If leave begins less than 5 weeks before the end of the term and leave is more than 2 weeks
long and return would occur during the 2 weeks before end of the term;
3) If leave begins less than 3 weeks before the end of the term and leave is more than 5 working
days and return would occur less than 2 weeks before the end of the term.
Employee Notice Requirement
Employees requesting Family and Medical leave must observe the same call in procedures as for
sick time, but in addition to notifying their immediate supervisor, they should contact the
appropriate administrator, i.e., Pastor, Principal, or Human Resources (for ACC/Cemeteries
employees) to file their request for a leave of absence.
Procedure to Request Leave
Complete the Leave of Absence Request form and submit to supervisor/department head and the
appropriate administrator, i.e., Pastor, Principal, or Human Resources (for ACC/Cemeteries
employees) for approval at least 30 days in advance of foreseeable leave (i.e., birth of child,
adoption) or with as much advance notice as is practicable.
Employees are required to provide certification and periodic recertification supporting the need
for the leave. For leave to care for an ill parent, spouse, legally domiciled adult, child or self,
provide a written statement from the physician certifying:
• The date on which the serious health condition commenced;
• The duration of condition;
• Appropriate medical facts;
• That the employee is needed to care for the seriously ill individual; or that the employee
is unable to perform the functions of the position;
• An estimate of amount of time employee is needed to care for the family member.
• If requesting leave to care for a servicemember (Military Caregiver Leave), you must
provide a written statement from a U.S. Department of Defense (DOD) authorized health
care provider or Veterans Affairs health care provider confirming that the covered
servicemember’s injury or illness was incurred in the line of duty on active duty and
requires care.
• In order to return to work, all employees returning from medical leave must present a
doctor’s note fully releasing them to return to work. If your doctor releases you to return
to work with any restrictions, a decision about your return to work will be evaluated
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